title: Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of ticagrelor and generic clopidogrel as add-on therapy to acetylsalicylic acid (ASA) in patients with acute coronary syndrome (ACS), from a Swiss perspective.
  
  
  METHODS
  Based on the PLATelet inhibition and patient Outcomes (PLATO) trial, one-year mean healthcare costs per patient treated with ticagrelor or generic clopidogrel were analysed from a payer perspective in 2011. A two-part decision-analytic model estimated treatment costs, quality-adjusted life years (QALYs), life years and the cost-effectiveness of ticagrelor and generic clopidogrel in patients with ACS up to a lifetime at a discount of 2.5% per annum. Sensitivity analyses were performed.
  
  
  RESULTS
  Over a patient's lifetime, treatment with ticagrelor generates an additional 0.1694 QALYs and 0.1999 life years at a cost of CHF 260 compared with generic clopidogrel. This results in an Incremental Cost Effectiveness Ratio (ICER) of CHF 1,536 per QALY and CHF 1,301 per life year gained. Ticagrelor dominated generic clopidogrel over the five-year and one-year periods with treatment generating cost savings of CHF 224 and 372 while gaining 0.0461 and 0.0051 QALYs and moreover 0.0517 and 0.0062 life years, respectively. Univariate sensitivity analyses confirmed the dominant position of ticagrelor in the first five years and probabilistic sensitivity analyses showed a high probability of cost-effectiveness over a lifetime.
  
  
  CONCLUSIONS
  During the first five years after ACS, treatment with ticagrelor dominates generic clopidogrel in Switzerland. Over a patient's lifetime, ticagrelor is highly cost-effective compared with generic clopidogrel, proven by ICERs significantly below commonly accepted willingness-to-pay thresholds.
authors.affiliation: IMS Health, Munich, Germany; dgasche@es.imshealth.com.
authors.forename: David
authors.initials: D
authors.lastname: Gasche
authors.forename: Tanja
authors.initials: T
authors.lastname: Ulle
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Roger-Axel
authors.initials: RA
authors.lastname: Greiner
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics* / Q000628:therapy; D000241:Adenosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000191:economics; D004311:Double-Blind Method; D016527:Drug Costs / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000191:economics; D016568:Drugs, Generic / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D015425:Myocardial Reperfusion / Q000191:economics; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013557:Switzerland; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D016568:Drugs, Generic; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin